Date :.
.2014.
Place:- Malda.
(
)
P.S.B. No.
P.P.A. No.
To
The Chief Personnel Officer,
Eastern Railway,
Kolkata.
.
One Passport size
photograph to be
tagged
duly
attested by the
Departmental
Officer
(Through Proper Channel)
One Passport size
photograph to be
pasted & signed
across
by
the
Applicant and duly
attested by the
Departmental
Officer.
Sub. : No Objection Certificate
Kindly arrange to issue No Objection Certificate in my favour to obtain an International Passport/Renewal of
Passport as it is required by the Passport Issuing Authority i.e, Government of India, Ministry of External Affairs. In this
connection, this is to inform you that I may have visit ……………………………………………………………….. as a Tourist or
………………………………………………………………………………………………………………………….
.D E C L A R A T I O N (As per Sl. No. : 66/85)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
I am a citizen of India.
I shall not or likely to engage myself outside India in activities prejudicial to the sovereignty and integrity of
India.
My departure from India will not or likely to be detrimental to the security of India.
My presence in outside India will not or likely to prejudice friendly relation of India with my foreign country.
I have not been any time during the period of 5 years immediately residing from the date of application
convicted by a court of India for any offence involving moral turpitude and sentenced in respect thereof to
imprisonment for more than two years.
No warrant or summons for the appearance or a warrant for any arrest has been issued by a court under any
law for the time being in force or an order prohibiting my departure from India has been made by any such
court.
No proceeding in respect of an offence alleged to have been committed by me or pending before a criminal
court of India.
I have not been repatriated.
I am not under order of suspension or discharge or any departmental proceedings is pending against me.
I am not likely to put the Railway Administration in an embarrassing position in any way if I am allowed to
travel …………………………………………………………. (Name of Country).
During my visit to ……………………………………………. (Name of Country). I will expense my money in
“Dollar”/………….. and the said amount to be from my Savings Account. No. ……………………………….
I will stay during my visit at ………………….. (Name of Country), Address : ………………………………
Two passport size photographs duly attested by departmental Officer are enclosed herewith.
Proforma as per CPO/KKK’s Sl. No. 68/05 duly filled in is enclosed herewith also.
DA : As stated.
Thanking you.
Yours faithfully,
Dated, Malda, the ……..
day of ……………………., 200…..
Signature of Deptt. Officer with Seal
Name & Designation
Signature of Sr. Supervisor with Seal